Dry eyes: Progress in diagnosis and treatment

"There has been a growing interest among clinicians and patients on treatment and management and origins of the signs and symptoms of dry eye," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. "This month's feature issue is entirely dedicated to papers on dry eye disease, the risk factors, its diagnosis, and management."

Expert Updates on Dry Eye Disease--New Approaches to Diagnosis and Treatment

About 25 percent of patients visiting their optometrist or ophthalmologist report problems related to dry eyes, according to an introductory editorial by Meng C. Lin, OD, PhD, of University of California, Berkeley, and her Guest Editor colleagues. Especially since different conditions or diseases affecting the ocular surface can lead to similar symptoms, "Diagnosing, treating, and managing patients with dry eye symptoms can be challenging and frustrating to both clinicians and patients," the Guest Editors write.

Over the past decade, eye care professionals have gained an increased appreciation of how dry eyes can negatively affect the quality of life--and made "significant strides" in improving care for patients with dry eye symptoms. The special paper assembles 27 papers from expert clinicians and researchers, providing updates in five key areas:

Risk Factors

Many and varied factors have been linked to an increased risk of dry eye: including Asian race/ethnicity, contact lens wear, glaucoma medications, and LASIK surgery. Isotretinoin used to treat acne can also lead to dry eye; incomplete blinking may be an under-recognized cause. An important contributing factor is dysfunction of the meibomian glands--the main source of tear lipids--leading to faster evaporation of tears.

Diagnosis

"A stable tear film is essential for maintaining ocular surface homeostasis and for providing good vision and ocular comfort," Dr. Lin and colleagues write. However, several papers in the special issue highlight the difficulties of assessing tear film stability. Available diagnostic tests have significant limitations, while some newer tests for dry eye remain unproven.

Treatment and Management

"In today's society, even healthy eyes can experience temporary discomfort due to prolonged reading or viewing of computers or other electronic devices," according to the guest editors. Software and phone apps can remind users to take "visual breaks," or to blink more often to minimize stress to the tear film.

Other current and emerging treatments addressed in the special issue include omega-3 supplements and various forms of heat therapy, including a new "thermal pulsation system." Ongoing research on the constituents and factors regulating the tear film may lead to effective new treatment strategies.

Clinical Perspectives

While one paper in the special issue even questions the use of the term "dry eye," another argues that diagnosing the cause of dry eye symptoms is essential for more effective management. While many current treatment options for dry eye are "primarily palliative," Dr. Lin and colleagues note that there's "hope for advanced treatments emerging through the pipeline."

"The papers in our September special issue raise new hope for upcoming approaches and bring new ideas and advances to the eye care community," Dr. Adams adds. "Our internationally known expert Guest Editors have done a superb job in putting this together."

Special issue: http://journals.lww.com/optvissci/pages/currenttoc.aspx